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Related Concept Videos

Urologic Endoscopic Procedure: Cystoscopic Examination01:28

Urologic Endoscopic Procedure: Cystoscopic Examination

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Meaning of Cystoscopic Examination:Cystoscopy is an essential diagnostic tool in urology that is used to assess the structure and function of the genitourinary system. It provides a direct view of the urethra, bladder, and, in some cases, the ureteral openings. This procedure helps detect structural abnormalities, infections, cancers, and blockages in the urinary tract. There are two types of cystoscopy:Flexible cystoscopy is commonly performed in outpatient settings due to its less invasive...
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Procedures for Kidney StonesMedical intervention is necessary when kidney stones or renal calculi are too large to pass spontaneously (typically greater than 5 millimeters) when stones are accompanied by symptomatic infection (such as fever or pyelonephritis), when they impair kidney function, or when they cause persistent symptoms like severe pain, nausea, or urinary retention. Additionally, patients with only one kidney or those who cannot be treated with medical management also require...
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Updated: Jul 20, 2025

Technical Modification of the Terminal Ureter During Total Transperitoneal Laparoscopic Nephroureterectomy for Upper Urinary Tract Urothelial Carcinoma
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Lessons Learned from Routine Intraoperative Ureteral Margin Frozen Sections during Radical Cystectomy.

Michael J Whalen1, Jamie Lynn RiChard1, Rashed Ghandour1

  • 1Department of Urology, Columbia University Medical Center, College of Physicians & Surgeons, New York Presbyterian Hospital, New York, New York.

Urology Practice
|August 4, 2023
PubMed
Summary
This summary is machine-generated.

Intraoperative ureteral frozen sections during radical cystectomy are accurate and safe. Converting positive margins to negative improved patient survival, without increasing complications or upper tract recurrence.

Keywords:
biopsycystectomyfrozen sectionureteral neoplasmsurinary bladder neoplasms

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Area of Science:

  • Urology
  • Surgical Pathology
  • Oncology

Background:

  • Radical cystectomy is a major surgery for bladder cancer.
  • Ureteral margin status is critical for oncologic outcomes.
  • Intraoperative frozen section analysis aids surgical decision-making.

Purpose of the Study:

  • To evaluate the practice of intraoperative ureteral frozen sections during radical cystectomy.
  • To assess the impact of positive ureteral margins on surgical outcomes and recurrence.
  • To determine the effectiveness of frozen section conversion to negative margins.

Main Methods:

  • Retrospective review of 241 patients undergoing radical cystectomy (2004-2011).
  • Analysis of 590 intraoperative ureteral frozen sections for positivity and conversion rates.
  • Logistic regression for predictors of operative time, diversion changes, and recurrence.

Main Results:

  • 12.9% of frozen sections were positive; 82% were converted to negative.
  • Frozen sections demonstrated 100% sensitivity and 93.6% specificity.
  • Conversion to negative margins correlated with improved overall survival.
  • No increase in complications or change in urinary diversion was observed.

Conclusions:

  • Intraoperative ureteral frozen sections are highly accurate and safe during radical cystectomy.
  • Successful conversion of positive to negative margins improves overall survival.
  • The high conversion rate and long follow-up may explain the lack of association with upper tract recurrence.